Monnax/Monnax Plus

Aluminum Hydroxide + Magnesium Hydroxide + Simethicone (Monnax Plus) Chewable Tablet is a mint a green mottled, round, flat chewable tablet, plain on both sides with characteristics odor.
Each chewable tablet contains: Aluminum Hydroxide, USP 200 mg, Magnesium Hydroxide 200 mg, Simethicone 25 mg.

Pharmacologic Classification: Antacids.
Pharmacology: Pharmacodynamic: Aluminum hydroxide is a slow-acting antacid and magnesium hydroxide is fast acting. The 2 are frequently combined in antacid mixtures. Aluminum hydroxide on its own is astringent and may cause constipation. This effect is balanced by the effect of magnesium hydroxide, which, in common with other magnesium salts, may cause diarrhea.
Pharmacokinetic: The absorption of aluminium and magnesium from antacids is small. Aluminum hydroxide is slowly converted to aluminium chloride in the stomach. Some absorption of soluble aluminium salts occur in the gastrointestinal tract with urinary excretion. Any absorbed magnesium is likewise excreted in the urine.

Monnax: As an antacid for the symptomatic relief of hyperacidity in general.
Monnax Plus: Chewable Tablet: Reduction of gastric hyperacidity. Relief of bloating commonly associated with hyperacidity and other conditions. Adjunctive treatment of peptic ulcer.
Oral suspension: Symptomatic relief of hyperacidity associated w/ peptic ulcer, gastritis, esophagitis & dyspepsia. Antiflatulent to alleviate the symptoms of gassiness including post-op gas pain associated w/ hyperacidity. Adjunct to H2-blockers or proton pump inhibitors for rapid relief of ulcer symptoms.

Monnax Plus chewable tablet: Tablet may be chewed then swallowed without water or swallowed whole with water.
Recommended Adult Dose: 1 to 2 tablets to be taken 1 hour after each meal and at bedtime. Or, as prescribed by the physician.
Since aluminum hydroxide, magnesium hydroxide, and simethicone is used when needed, the patient may not be on a dosing schedule. Skip any missed dose if it's almost time for the next dose. Do not use two doses at one time.
Monnax/Monnax Plus oral suspension: Two to four teaspoonfuls (10-20 mL) four times a day taken 20 minute to 1 hour after meals and at bedtime.

Monnax Plus chewable tablet: There is very little experience of intentional overdose. Overdose with aluminum salts is easier to detect in patients with severe chronic kidney failure who have the following symptoms: encephalopathy, seizures and dementia. As in all cases of overdose, treatment is symptomatic and involves general supportive measures.
Treatment of overdose with magnesium: Rehydration, forced diuresis. Hemodialysis or peritoneal dialysis is required in patients with kidney failure.
In case of accidental ingestion or absorption of an excessive dose, immediately inform the doctor or go to the nearest hospital.
If the patient thinks there has been an overdose, call the poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Monnax/Monnax Plus oral suspension: Reported symptoms of acute overdose with aluminium hydroxide and magnesium salts combination include diarrhea, abdominal pain, vomiting. Large doses of this product may trigger or aggravate intestinal obstruction and ileus in patients at risk.
Aluminium and magnesium are eliminated through urinary route; treatment of acute overdose consists of administration of IV Calcium Gluconate, rehydration and forced diuresis. In case of renal function deficiency, haemodialysis or peritoneal dialysis is necessary.

It is contraindicated to the patients who is suffering from kidney failure.
Monnax plus chewable tablet: Monnax plus chewable tablet should not be used during pregnancy unless considered essential by the physician. Allergy to any ingredient in the product.
If the patient has: Kidney disease; intestinal obstruction; appendicitis; fecal impaction; gastric outlet obstruction; phosphate depletion and low serum phosphate; osteomalacia (softening of the bones).

Do not take more than 16 teaspoonful (80 mL) in a 24-hour period or use the maximum dosage for more than two weeks. Do not use if patient has kidney disease except under the advise and supervision of a physician.

Monnax Plus chewable tablet: This medicine can make it harder for the body to absorb other medicines, especially certain antibiotics. Avoid taking any other medicines within 2 hours before or 2 hours after the patient takes aluminum hydroxide, magnesium hydroxide, and simethicone.
Do not take more than the maximum dose recommended on the medicine label. Do not take this medicine at maximum doses for longer than 2 weeks in a row. An antacid is usually taken for a short time until the symptoms clear up. Call the doctor if symptoms do not improve within 2 weeks of taking this medicine.
The patient should consult a doctor or pharmacist if this medicine is safe to use if the patient has: kidney disease or if they are on a low-magnesium diet.
Ask a doctor before using this medicine if the patient is pregnant or breastfeeding.
Do not give this medicine to a child younger than 12 years old without medical advice.
Monnax/Monnax Plus oral suspension: Aluminum hydroxide may cause constipation due to its astringent action, this effect may be balanced by the cathartic effect of the magnesium salts. Aluminum hydroxide may lead to a phosphate depletion syndrome, particularly in patients on a low phosphate diet eg, malnutrition. Magnesium salts may cause central nervous depression in the presence of renal insufficiency and should be used with caution in patients with advance renal disease. In patients with renal impairment, plasma levels of both aluminum and magnesium increase. In these patients, a long-term exposure to high doses of aluminum and magnesium salts may lead to encephalopathy or worsen dialysis osteomalacia. The prolonged use of antacids in patients with renal failure should be avoided.

Should not be used during pregnancy unless considered essential by the physician.

Monnax Plus chewable tablet: The combination of Aluminum Hydroxide and Magnesium Hydroxide balances the side effects of diarrhea from Magnesium Hydroxide and constipation from Aluminum Hydroxide. Excessive doses of Aluminum Hydroxide and Magnesium Hydroxide may result in high Aluminum and Magnesium levels in the blood in patients with kidney impairment.
Monnax/Monnax Plus oral suspension: May cause diarrhea or constipation.

Monnax Plus chewable tablet: Antacids decrease the absorption of Tetracycline and Iron. Take Tetracycline 1 hour before or 2 hours after antacids and 2 hours before or 3 hours after iron-containing preparations.
Antacids may decrease the absorption of orally administered Digoxin, or Indomethacin, Isoniazid, Quinolones (e.g. Ciprofloxacin, Ofloxacin), Ketoconazole. Doses of these should be spaced as far as possible from doses of antacids.
Antacid-induced changes in urine pH increase urinary excretion and decrease blood concentration of salicylates such as Aspirin.
Antacid-induced increases in urine pH may decrease excretion of weakly basic drugs (e.g. Quinidine, Chlorpromazine, Propranolol, Diazepam) and increase excretion of weakly basic drugs (e.g. Phenytoin, Pentobarbital, Warfarin).
Aluminum-Magnesium antacid combination is reported to increase the absorption of Dicumarol, Diazepam and Pseudoephedrine.
Magnesium and Aluminum Hydroxide administration may decrease the rate of Chlordiazepoxide absorption.
Antacids reduce the bioavailability of bisphosphonates (e.g. Alendronate, Etidronate, Risedronate).
Monnax/Monnax Plus oral suspension: Aluminium hydroxide may form complexes with certain drugs eg, tetracyclines, digoxin and vitamins, resulting in decreased absorption. This should be borne in mind when concomitant administration is considered.
Concomitant use with quinidines may increase the serum levels of quinidine and lead to quinidine overdosage.
Aluminium-containing antacids may prevent the proper absorption of H2-antagonists, atenolol, chloroquine, cyclines, diflunisal, digoxin, diphosphonates, ethambutol, fluoroquinolones, sodium fluorine, glucocorticoids, indomethacin, isoniazid, kayexalate, ketoconazole, lincosamides, metoprolol, neuroleptics, phenothiazines, penicillamine, propranolol, iron salts.
Staggering the administration times of the interacting drug and the antacid by at least 2 hrs (4 hrs for the fluoroquinolones) will often help avoid undesirable drug interactions.

Store at temperatures not exceeding 30°C.
Monnax/Monnax Plus oral suspension: Once opened, use within 28 days of opening.

Antacids, Antireflux Agents & Antiulcerants

A02AF02 - ordinary salt combinations and antiflatulents ; Belongs to the class of antacids with antiflatulents.
A02AD01 - ordinary salt combinations ; Belongs to the class of combinations and complexes of aluminium, calcium and magnesium-containing antacids.

Non-Rx